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Rye grass is one of the main causes of thunderstorm asthma.
- ABC licensed

It was a warm spring afternoon in Melbourne, and Apollo Papadopoulos was finishing work. But he felt sick.

He had used his asthma relief medication during the day, but called his mother that night to pick him up from a friend's place, as he felt too unwell to drive.

She found her son distressed and leaning on his car, short of breath and unable to speak.

An ambulance was called, but Mr Papadopoulos collapsed before it turned up.

Paramedics tried to resuscitate him as the ambulance made its way to the hospital, but he died shortly after it arrived.

Mr Papadopoulos, from Thomastown, was only 35 years old and one of 10 people who died as a result of the so-called severe allergic asthma during Melbourne's .

University of Melbourne allergy specialist, Professor Jo Douglass, said victims may have had a greater chance of survival if the seriousness of their symptoms had been noticed by people around them.

She gave detailed evidence in the opening of the coronial inquest into the deaths, and told the court there was 15 minutes, on average, between the victims experiencing severe symptoms and when they entered cardiac arrest.

Several of the victims, including Mr Papadopoulos, reported shortness of breath and were unable to speak before they collapsed.

"If that had been recognised sooner, there would have been time to respond with treatment more likely to be effective," Professor Douglass told the court.

Thunderstorm asthma hotspot

Melbourne is known as a global hotspot for thunderstorm asthma because of grass grown in the northern parts of Victoria.

It was a hot, windy day on November 21, 2016. The temperature in the city hit 35 degrees Celsius before a cool change and thunderstorms around 5:00pm.

The conditions were right for a perfect storm â€” rye grass pollen swept in from the countryside north-west of Melbourne and became saturated with water. The pollen burst into very fine particles, sparking asthma-like symptoms in thousands of people across the city.

By 6:00pm, authorities received an unprecedented surge of calls for ambulance assistance.

Professor Douglass said there were four to six thunderstorms every year in November and December "and we have one of these events only every three to five years".

"So not every thunderstorm does this," Professor Douglass said.

"It's not as clearly understood as it might [be]."

She was asked about what primary medical carers â€” GPs and pharmacists â€” knew about thunderstorm asthma before that incident.

"I don't think they were very aware," Professor Douglass said.

"I don't think they really thought about it."

Cases show similarities

Omar-Jamil Moujalled, an 18-year-old school student from Greenvale, reported severe symptoms an hour after the cool change. Around an hour after the symptoms, he died.

The court heard Mr Moujalled collapsed at the local medical clinic, shortly after arriving with his mother. It took some time to get through to triple-0, and the clinic had a defibrillator but the teen was "not shockable", according to Professor Douglass.

Professor Douglass told the court some patterns had emerged from her examination of the patient files, police reports, pathology results and the statements from families.

Professor Douglass said all the victims had been diagnosed with asthma at some point before the event, but that several victims were notably affected when they went outside.

The victims were mostly men, with an average age of 36, and were predominantly from Asian backgrounds who had recently immigrated to Australia.

Professor Douglass hypothesised they seemed to have developed allergies within three or four years of arriving.

The court also heard eight of the victims were from Melbourne's north-west, where the storm might have hit hardest, but that socio-economic conditions and access to treatment might have been a factor.

A severe tropical cyclone brewing north of Western Australia has intensified more rapidly than expected, reaching a category four severity and prompting warnings of heavy rainfall, damaging winds and a destructive storm surge along coastal areas.

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